Dentinogenesis gigi

Multidisciplinary Approach in Management of Fractured Incisor....Sushil K C et al

CASE REPORT

Journal of International Oral Health. Jan-Feb 2013; 5(1):79-82 [ 79 ]

Multidisciplinary Approach in Management of Fractured Central

Incisor through Composite Plug Stabilization - A Case Report Sushil Kumar C1, Amit Rao2, Sheila K3, Hanumanth Reddy G4

1Reader, Department of Conservative and Endodontics, Dr.H.S.R.S.M Dental College Hingoli, Maharashtra, India; 2Professor ,Department of

Oral and Maxillofacial Surgery, Dr.H.S.R.S.M Dental College Hingoli, Maharashtra, India; 3Senior lecturer, Department of Pediatric and

Preventive dentistry, Dr.H.S.R.S.M Dental College Hingoli, Maharashtra, India; 4MDS, Professor, Department of Orthodontics, Chhattisgarh

Dental College & Research Institute, Rajnandgaon, Chhattisgarh, India.

Introduction:

Traumatic injuries to the teeth and the supporting

structures are one of the few areas in dentistry

that should be considered as an emergency.

Crown fracture is the most frequent injury in

permanent dentition. Apart from loss of hard

tissue, this injury represents hazard to pulp.

Traumatized anterior teeth requires quick

functional and esthetic repair. Traditionally such

injuries have been restored with conventional

post-core and crown techniques after endodontic

treatment. Several factors influences the

management of coronal tooth fractures including

extent of fracture, pattern of fracture and the

restorability of the tooth, presence or absence of

the fractured tooth fragment, occlusion and

esthetics1.

Complicated crown fracture in a mature anterior

tooth should be immediately treated with method

of isolation and restoration becomes difficult.

Restoration of esthetics is one of the main

concerns in such teeth2. This article presents an

innovative technique of managing a complicate

crown fracture of anterior tooth where plain

orthodontic band was used for stabilization and

post endodontic restoration was done with

adhesively luted fiber reinforced composite post .

Case Report:

A 17 years old female patient walked into

department of Conservative dentistry and

Endodontics Dr.H.S.R.S.M Dental College at

Hingoli, Maharashtra, sustaining a complicated

crown fracture to her left upper central incisor.

The patient’s history for allergy or systemic

ABSTRACT

Crown fracture is the most frequent type of traumatic injury in permanent dentition. Traumatized anterior teeth

requires quick functional and esthetic repair. Traditionally such injuries have been restored with conventional

post-core and crown techniques after endodontic treatment. This article presents an innovative technique of

managing a complicate crown fracture of anterior tooth where plain orthodontic band was used for stabilization

and post endodontic restoration was done with adhesively luted fiber reinforced composite post through fragment

and composite plug stabilization.

Key words: Traumatic injuries, Crown fracture, Composite plug.

How to cite this article: Sushil K C, Rao A, Sheila K, Hanumanth R G. Multidisciplinary Approach in Management

of Fractured Central Incisor through Composite Plug Stabilization - A Case Report. J Int Oral Health 2013; 5(1):79-

82.

Source of Support: Nil Conflict of Interest: None Declared Received: 11th November 2012 Reviewed: 12th December 2012 Accepted: 10th January 2013

Address for Correspondence: Dr. Sushil Kumar C, Access Dental Hospital, # 5, & 6 Satya complex, Golnaka

Alwal, Secunderabad-10. Email: [email protected]. Contact no.: 9704171797

[email protected]


CASE REPORT


Fig. 1: Pre-operative Photograph of the Fractured 21

Fig. 4: Post-operative Radiograph Fractured

Fig. 2: Stabilization Done with Orthodontic Band

Fig. 3: Pre-operative Radiograph

problems was non-contributory. Externally mild

swelling of the lip was observed. Intraoral clinical

examination revealed laceration in the alveolar

sulcus in relation to upper incisors. There was no

evidence of alveolar fracture. Clinically the upper

left central incisor presented with fracture lines

running across the crown where the conventional

technique of placement of rubber dam clamp and

achieving access was not possible. Stabilization

and approximation of the fragments was achieved

by using pre-formed orthodontic band, which

was cemented to the tooth by zinc phosphate

cement.

Root canal therapy was performed after proper

stabilization with the orthodontic band.

Stabilization with the band helped in achieving

better access and standard isolation with the help

of rubber dam. The tooth was treated

endodontically following conventional methods.

The major concern in this case was giving a

proper definitive restoration. After a week of root

canal treatment post space was prepared by

removing gutta-percha from the root canal space

using a no.2 Pezzo drill, leaving the apical third

intact. Later a fiber reinforced composite (FRC)

post (size 2) was selected. The post space was

etched for 15secs using 35% phosphoric acid,

washed thoroughly and air-dried. Then the post

space was painted with bonding agent and light

cured for 20secs. The post space was filled with

dual curing composite resin cement with the FRC

post in place and light cured at an angle of 450 for

40secs at three levels. In this case, bonding of

composite resin luting cement to the FRC post is

both chemical and mechanical bonding because of


CASE REPORT


Fig. 5: Placement of FRC Post

Fig. 6: Grooves prepared along Fracture Lines.

Fig. 7: After Fragment Strengthening

Fig. 8: Provisional Crown.

the isoelastic properties of the resin cement, post

and dentin.

In this case, the composite core build-up was

replaced by the fragment strengthening of the

fractured crown to prevent the natural tooth

structure and provide better esthetics. Fragment

strengthening of the fractured crown was

performed by preparing 3mm of deep grooves of

0.8mm width along the fracture lines leaving the

incisal edges. Later composite cement was used

along the grooves and light cured. From the post

space to the fragment stabilisation resin cement

and composite material was used for establishing

a plug for better integration and bond strength.

This technique of composite plug stabilization

exhibits better bond strength between the luting

materials, root dentin and FRC posts5. After a

week’s follow-up the tooth was restored with a

provisional crown.

Discussion:

The aim of endodontic and restorative treatment

is to restore the function, form and esthetics.

Esthetics has an impact on psychology of an

adolescent patient when it comes to anterior teeth.

Traditionally cast posts have been used for

restoration of endodontically treated teeth with

complicated crown fracture. Recent advancements

in adhesive dentistry lead to the usage of fiber-

reinforced resin-based composite posts with resin

composite build-ups especially with teeth in the

esthetic zone are considered such as maxillary

anterior teeth6.

Usage of FRC post along with resin cement helps

in distribution of stresses along the tooth structure


CASE REPORT


uniformly thus decreasing the chances of post

endodontic failure. Because of the isoelastic

properties and similar modulus of elasticity of the

FRC post, resin cement and dentin increases the

retention and provides monoblock effect5.

In this case stabilization of the fractured

fragments was achieved by orthodontic band

which helped in retention of natural tooth

structure and establishment of esthetics. This

technique employed was an excellent means of

stabilization of the fractured teeth and prevented

its demise during the root canal treatment7.

Fragment strengthening of the fractured crown

was possible in this case as there was absolutely

no loss of the crown structure apart from the

fracture lines running across the tooth. As the

original contour was intact, the natural tooth

structure acted as biological contour for better

resistance.

Conclusion:

In a traumatic injury to the tooth, the success of

the endodontic treatment depends on the

remaining tooth structure. Though a FRC post

was used for support maximum effort was put to

save the natural tooth structure for better esthetics

and function. The current case report illustrates a

viable and conservative technique by which the

fractured tooth can be stabilized without any

fragment loss through which both function and

esthetics were established.

References:

1. Macdeo GV, Diaz PI, De O Fernandes CA.

Reattachment of Anterior Teeth Fragments: A

Conservative Approach. J Esthet Restor Dent;

2008;20:5-20.

2. Andreason FM, Andreasen JO. Crown root

fractures: Textbook and colour atlas of

traumatic injuries to the teeth, 3rd edition.

Copenhagen, Munksgaard, 1994;219-56.

3. Ingle J, Bakland LF. Endodontic

considerations in dental trauma. Endodontics,

5th edition. Elsivier.2002;795.

4. ZJohn SR. Advanced endodontics. Clinical

Retreatment and Surgery, 2nd edition. New

York, 2006;17.

5. Tay FR, Pashley DH. Monobloks in root

canals: A hypothetical or a Tangible Goal.

J.Endod 2007;33:391-8.

6. Reis A, Kraul A. Reattachment of fractured

teeth, A review of literature regarding

techniques and materials. Oper Dent.

2004;29(2):226-33.

7. Reis A, Kraul A. Francei C. Reattachment of

anterior fractured teeth. Fracture strength

using different materials. Oper Dent.

2008;27:621–7.

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